Thursday, 5 February 2015

(First edited)) Most Common Diseases of Ages of 50 Plus - Musculoskeletal disorders (MSDs) -Cervical Stenosis with Myelopathy

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By Kyle J. Norton
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Cervical Stenosis with Myelopathy

Cervical Stenosis is condition of degeneration of the structures of the spine as a result of aging. Spinal stenosis causes pressure on the spinal cord, leading to the symptoms of myelopathy. Cervical spinal stenosis with myelopathy is a common disease in elderly patients of male gender(2).

A. Symptoms
Symptoms are as of result of neurologic disease which can lead to progressive disability and eventual paralysis if without appropriate treatment, depending to the expression of the exact distribution of the myelopathy in the spinal cord. Most elders with Cervical Stenosis are experience painless symptoms, others may be experience one of more symptom, depending to the location of the compression and dysfunction of spinal cord.
1. Increased knee and ankle reflex may be a first sign of the disease
2. Tightness of gait and numbness of the legs, depending to the expression of the exact distribution of the myelopathy in the spinal cord of the individual patient, such as weakness, difficulty walking, frequent falls, etc.
3. Pins-and-needles (paraesthesia) sensation in the whole body.
4. Muscle weakness or paralysis
5. Deterioration in fine motor skills (such as handwriting or buttoning a shirt)
6. Intermittent shooting pains into the arms and legs (like an electrical shock), especially when bending their head forward (known as Lermitte’s phenomenon)
7. Arm and neck pain as a result of the myelopathy constitute a combination of cord failure at the affected level and of compression and irritation of the cervical nerve roots which leave the neck at this site, such as weakness, stiffness or clumsiness in the hands,
8. Loss of appreciation of temperature, pain and joint sense and often with impairment of bladder and bowel control, as a result of the transverse lesion of the spinal cord effecting modalities of cord transmission with spasticity of gait and increased tendon reflexes, in the later state of (3).
9. Etc.

B. Causes of risk factors
B.1. Causes
Cervical Stenosis with myelopathy may be result of degenerative changes within the spine or bone spurs, due to genetics, and wear and tear of daily living, causing the size of the spinal canal becoming smaller and bone spurs pressing on the spinal cord or the nerve roots. Tumor located between the spinal cord and vertebrae can cause Cervical Stenosis with Myelopathy.

B.2. Risk factors
1. Aging and gender
If you are male and over 50 years of age(3a), you are at higher risk to develop Cervical Stenosis with Myelopathy.

2. Genetics
Congenital narrowing of the cervical spinal canal may result in cord compression without a history of injury and  evidence of significant bony degenerative changes(4).

3. Wear and tear of daily living
Tear and wear, injure cause of scar tissues and weaken the function of disc in absorbing shock(4a), may induce pressure on the spinal cord.

4. Injure(4a)
Injure to the spine can cause scar tissues, leading weaken the spinal tissues, such as thickened ligaments.
5. Etc.

C. Complications
1. Numbness and paresis

Patient with similar cervical spinal cord injury in the past may develop transient numbness and paresis of  of the lower limbs(5).

2. Incontinence 
  Degenerative spinal disease  can result in acute or chronic urinary incontinence, depending to   gender, BMI, radicular weakness and the type of degenerative disease. Surgical treatment showed to improve or eliminate the symptoms of urinary incontinence in more than half of the patients affected(6).

4. Paralysis 
Cervical stenosis can cause increased risk of paralysis(7a), depending on where the spinal cord and nerve roots are damaged by Cervical Stenosis.

5. Chronic pelvic pain and infertility
Cervical stenosis condition often recurs despite intervention. women who encounter ecurrent stenosis are at risk of developing severe complications such as chronic pelvic pain and infertility(7).
6. Etc.

D.  Diagnosis
The aim of the diagnosis is to find the causes of the pain. After a complete history and physical exam, the tests your doctor ordered may include
1. X ray
X ray may be the first examination ordered by your doctor to detect the presence of Cervical Stenosis.

2. Computed Tomography (CT) Scan 
A CT scan generates a large series of two-dimensional X-ray images taken around a single axis of rotation, to create a three-dimensional picture of the inside of the body in details.The pictures are viewed by your doctor to see the extent of the Cervical Stenosis.

3. Magnetic Resonance Imaging (MRI) 
MRI (magnetic resonance imaging) is one of many advanced technology used to visualize internal structures cross sectional imaging of your body used effectively in providing the better details of the Cervical Stenosis and surrounding areas.

4. Myelogram
Myelogram is an X-ray of your spine taken with a injection of special dye into the spinal column for your doctor to examine the pressure on the spinal cord or problems with discs or vertebrae or tumor between the spinal cord and vertebrae.
5. Etc.

E. Cervical Stenosis with Myelopathy Prevention
E.1. The do’s and do not’s list

1. Maintain a healthy weight
Lose weight if you are over weight or obesity, excess weight places more pressure on the spinal column and especially on the intervertebral discs, leading to congenitally narrow canal risk of developing cervical spinal stenosis, according to University of California at Los Angeles.

2. Exercise(8a)
Regular morderate exercise such as aerobics, strength and flexibility exercises, aerobic exercises not only help to slow the rate of age degeneration, but also enhance the general fitness of the whole body, including exercises to strengthen your back, legs and arms as well as keeping your abdomen strong therefore offering more support for your back.

3. Quit smoking
Smoking can increase the risk of free radical attacks of which can cause early aging and aging effects. According to the theory of free radicals “A free radical is any atom or molecule that has a single unpaired electron in an outer shell and highly reactive to react with other cell, which in turn, causes oxidative damage to the enzymes, other protein, unsaturated fatty acid, phospho-lipids, DNA and RNA, etc., leading to aging of the organisms, as a result of widespread damage due to set of a chain reaction auto-catalytically after attacking the lipid bilayers of the cell walls”(8).

4. Eating healthy
Eating healthy can not only reduce the progression of aging(8b) but also the risk of diseases that cause Cervical Stenosis

 5. Etc.

E.2. The Diet
Healthy foods maintain a healthy weight, enhance immune system, delay aging can reduce the risk of  Cervical Stenosis.
1. Green tea
EGCG, found abundantly in green tea significant enhance longevity-extending effects, through its  free radical-scavenging effects and up-regulating effects on stress-resistance-related proteins, including superoxide dismutase-3 (SOD-3)  in vitro and in vivo, according to Chinese Academy of Science, showed that the survival-enhancing effects of EGCG on C. elegans under stress are very important(9).

2. Avocados
 Methanolic (80%) extracts obtained from lyophilized ground peels and seeds of avocado (Persea americana Mill.) of the Hass and Shepard varieties exhibit theirs antioxidant activity in does of  0.16 and 0.47 mmol Trolox/g(10).

3. Skin and seed of grape
Resveratrol found abundantly in grape skins and  seeds  possesses diverse biochemical and physiological properties including anti-inflammatory and immunomulatory, antiaging properties, etc.(11).

4. Organic soy
  Isoflavones, a major phytochemical found in soy demonstrated the antioxidant effect against in rats with myocardial infarction (MI), through increased activity of antioxidant enzyme activity and nitrite/nitrate content(12).

5. Turmeric
 Curcumin treatment of both 6 and 24 months old rats demonstrated the antioxidative, antilipofusinogenesic and anti-ageing effects of curcumin in the brain, according to the study of Jawaharlal Nehru University(13).
6. Etc. 

E.3. Antioxidants to prevent Cervical Stenosis(13)
Antioxidants are proven to be effective to enhance the immune system in fighting against the forming of free radicals causes of irregular cell growth and the progression of early aging.
1. Bilirubin
Bilirubin, a cellular antioxidant with function in breaking down molecules into smaller units in releasing energy and excreting in bile and urine, when oxidized that inhibits the effects of mutagens.

 2. Carotenoids
Carotenoids are organic pigments, occurring in the chloroplasts and chromoplasts of plants and some other photosynthetic organisms like algae, some bacteria.
 a. Beta-carotene
Beta-Carotene, an organic compound and classified as a terpenoid, a strongly-coloured red-orange pigment in plants and fruits.
a.1. Stored in liver for the production of vitamin A has shown to inhibits cancer cell in experiment. Beta-carotene also neutralize singlet oxygen before giving rise of free radicals which can damage of DNA cause of improper cell DNA replication.
a.2. Cell communication
  Beta-carotene enhances the communication between cell can reduce the risk of cancer by making cells division more reliable.
a.3. Immune system
Beta-carotene promotes the immune system in identifying the foreign invasion such as virus and bacteria by maintaining optimal function of white cells.
a.4. Polyunsaturated fat
 Beta-carotene also inhibits the oxidation of polyunsaturated fat and lipoprotein in the blood that reduce the risk of plaques building up onto the arterial walls cause of heart diseases and stroke.
a.5. There are more benefits of beta-carotene.

 b. Alpha-carotene
Alpha-carotene, one of the most abundant carotenoids in the North American diet, not only protects cells from the damaging effects of free radicals and enhances the immune system in fighting against bacteria and virus invasion, but also stimulates the communication between cells thus preventing irregular cell growth cause of cancers.

 c. Beta-cryptoxanthin
Beta cryptoxanthin, an antioxidant, beside preventing free radical damage to cells, it also stimulates the repair of oxidative damage to DNA and enhances the immune function infighting against inflammatory cause of polyarthritis, and irregular cell growth.

 d. Lutein
Lutein found in greens like kale and spinach and yolk of eggs, reduces risk of age related macular degeneration, an eye condition.
  Lutein deficiency may induce a cellular antioxidant related macular degeneration, leading blindness.

 e. Zeaxanthin
Zeaxanthin, a most common carotenoid alcohols found in nature, showed to lower the risk oxidative stress cause of incidence of age-related macular degeneration.

f. Lycopene
Lycopene, one of the most powerful antioxidants in the carotenoid group found in tomatoes, watermelons, and grapefruits, consists many anti-aging capabilities.

 3. Flavonoids
Flavonoids, the yellow pigments having a structure similar to that of flavones occurred in varies plants, process a property as antioxidants. it helps to neutralize many of reactive oxygen species (ROS), including singlet oxygen, hydroxyl and superoxide radicals.
 a. Quercetin
Quercetin, a plant-derived flavonoid found in fruits, vegetables, leaves and grains reduces the risks of free radical causes of damage cell membranes, mutation of cells with tampering DNA, through its consists  anti-inflammatory, antioxidant properties.

b. Rutin
Rutin, a citrus flavonoid glycoside found in buckwheat and glycoside of the flavonoid quercetin,  inhibits platelet aggregation, decreases the capillary permeability and reduce the risk of free radicals induced cytotoxicity of oxidized LDL cholesterol.

 c. Catechin
Catechin is a natural phenol antioxidant plant and natural anti-bacterial substance exhibits it free radical scavenging power in inhibition of ROS production.
d. Etc. 

F. Treatments
F.1. In conventional Medicine perspective

I. Non surgical treatments
1.1. Wait and watch
Wait and watch may be necessary if patients are experience no symptom and abnormalities to prevent diagnosis with the diseases some time in the future.

1.2. Medication
Certain medication such as non-steroidal anti-inflammatory drugs (NSAIDs), oral steroids, or injected steroids such as epidural steroid injections and nerve root injections may be helpful in relieving pain and alleviating symptoms temporary of the patients with no intention to correct any abnormalities or misalignment.

1.3. Physical therapy or exercise
Physical exercise such as stretching may be helpful to restore the flexibility of tight muscles
as well as enhancing the neck mobility, muscular strength and spinal balance. Other exercise, including Cardiovascular exercises for arms and legs also for promotion of blood circulation.
1.4. Etc.

2. Surgical treatments
Surgical treatments may be necessary if patients are experience the symptoms of increasing weakness, pain or inability to walk, etc. depending to differentiation
2.1. Anterior Surgery
Cervical Discectomy and Fusion (ACDF)
The aim of the surgery is to relieve pressure from the spinal cord and compression of the spinal. Anterior Cervical Discectomy and Fusion (ACDF) is the operation done from the front of the neck to remove the disc above and below the vertebra and replace it with a small plug of bone. If more than one level of the spine is involved. Cervical Spinal Fusion may be necessary by implanting a bone graft between cervical segments to support the spine as to compensate for the removal of bone and discs.

2.2. Posterior surgery
a. Laminectomy and Fusion
The aim of the surgery is also to relieve the pressure and to create more space for the nerves. In Laminectomy and Fusion, the lamina is removed and two or more vertebral segments of the cervical spine are fused together.

b. Laminoplasty
In case of Laminoplasty, only a small section of the bony roof of the spine, the lamina, is removed instead of removal of the lamina to expand the spinal canal with an aim to create a space for the the spinal cord.
2.3.  Etc.

F.2. In herbal medicine perspective
The aim of herbal medicine is to relieve symptoms of Cervical Stenosis
1. Cayenne
Cayenne used in traditional medicine to increases metabolism, enhance circulatory system and stomach and the intestinal tract, adjust blood pressure, lower LDL cholesterol and triglycerides, treat frostbite, muscles, arthritis, rheumatism, low back pain, strains, sprains, bruises and neuralgia, etc.,  also known as Cayenne Pepper, is a red, hot chili pepper, belonging to Capsicum annuum, the family Solanaceae, native to sub-tropical and tropical regions.
 According to  the 1Provincal Medical Centre in Ontario, in a randomized controlled trials, examining adults (over 18 years of age) suffering from acute, sub-acute or chronic non-specific low-back pain, cayenne showed to inhibit pain and improve quality of life for patients with chronic low-back pain(a)

2. Valerian
Valerian,  used as a sedative and relaxing agent and to treat the liver, the urinary tract, the digestive tract problem, nerve conditions, a perennial flowering plant, in the genus Valeriana, belonging to the family Valerianaceae, native to Europe and parts of Asia.
  Essential oil (VPAEO) from Valerian on experimental models showed to exerted its peripheral analgesic effects via inhibition of prostaglandin synthesis(b).

3. Etc.

F.3. In Traditional Chinese medicine perspective1. Compound Qishe Tablets, Jingfukang, Extractum Nucis Vomicae, etc.
 According to to randomized controlled trials with adults with a clinical diagnosis of cervical degenerative disc disease, cervical radiculopathy or myelopathy supported by appropriate radiological findings.
1. Compound Qishe Tablets showed to relieve pain better in the short-term than either placebo or Jingfukang.
2. Oral herbal formula of Huangqi ((Radix Astragali)18 g, Dangshen (Radix Codonopsis) 9 g, Sanqi (Radix Notoginseng) 9 g, Chuanxiong (Rhizoma Chuanxiong)12 g, Lujiao (Cornu Cervi Pantotrichum) 12 g, and Zhimu (Rhizoma Anemarrhenae)12 g) relieved pain better than Mobicox or Methycobal
3. Compound Extractum Nucis Vomicae, relieved pain better than Diclofenac Diethylamine Emulgel.(14)

2. Acupuncture
According to the study of  Neurochirurgischen Abteilung des Landeskrankenhauses Feldkirch, the treatment of chronic spinal pain is dominated by non-operative procedures. Acupuncture  does not only serve as treatment option for pain relief, but also and even more so has an harmonizing effect upon physical and psychological disturbances(15).

3. Etc.

Reprinted from Norton Journal, Volume I, Most Common Diseases of Ages of 50 Plus - Chapter of Musculoskeletal disorders (MSDs): Cervical Stenosis with Myelopathy by Kyle J. Norton  

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